P513: CPX-351 TREATMENT FOR ACUTE MYELOID LEUKEMIA IN ENGLAND: REAL-WORLD OUTCOMES IN ADULTS AGED &lt;60 YEARS VERSUS ≥60 YEARS
Authors: A. Legg, R. Muzwidzwa, A. Lambova, K. Styles, P. Doubleday, G. Medalla
Journal: HemaSphere (2022)

Background: CPX-351 (Vyxeos® liposomal) is a dual-drug liposomal encapsulation of daunorubicin and cytarabine in a synergistic 1:5 molar ratio. Since 2018, NICE and the EMA have recommended the use of CPX-351 for adults with newly diagnosed, therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC) due to prior myelodysplastic syndrome (MDS)/chronic myelomonocytic leukemia (CMML) or de novo AML with myelodysplasia-related cytogenetic changes. Aims: To compare the characteristics and overall survival (OS) of younger (18–60 years) versus older (≥60 years) adults with AML who were treated with CPX-351 in England. Methods: This retrospective study utilized the Cancer Analysis System database available through England's National Cancer Registration and Analysis Service. A diagnosis of t-AML or AML-MRC between 01/01/2013 and 31/03/2021 was determined either directly using International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes or indirectly using nonspecific ICD-O-2, ICD-O-3, or ICD-10 AML codes in combination with prior systemic anticancer therapy or radiotherapy (t-AML) or a prior diagnosis of MDS/CMML (AML-MRC). OS was estimated from the diagnosis date or landmarked from the hematopoietic cell transplantation (HCT) date. Results: Overall, 211 patients with AML received CPX-351; their median (IQR) age was 65 (59, 70) years, 133 (63%) were male, 187 (89%) were White, 87 (41%) had secondary AML (t-AML or prior MDS/CMML), 33 (16%) had other AML-MRC, and 91 (43%) had unspecified de novo AML. Of the 60 (28%) patients aged <60 years, 12 were aged 18–44 years and 48 were aged 45–59 years. Of the 151 (72%) patients aged ≥60 years, 97 were aged 60–69 years and 54 were aged ≥70 years. The cutoff date for OS was 31/08/2021, with a median (IQR) follow-up of 11.3 (4.7, 20.1) months. The estimated median OS (95% CI) was 12.9 (10.5, 17.5) months overall, 18.5 (11.0, not estimable) months for adults aged <60 years, and 11.2 (8.5, 15.9) months for adults aged ≥60 years, with 2-year survival of 35%, 44%, and 32%, respectively (Figure). Early mortality at 30 days was 6% overall, 3% for adults aged <60 years, and 7% for adults aged ≥60 years. Among adults aged <60 years, HCT was reported for 29/60 (48%) patients, including 29/50 (58%) with ≥3 months of follow-up. Among adults aged ≥60 years, HCT was reported for 55/151 (36%) patients, including 55/115 (48%) with ≥3 months of follow-up. When landmarked from the HCT date, median OS was not reached in either age group (Figure). In a treatment patterns analysis, after receiving CPX-351, 14/60 (23%) adults aged <60 years and 63/151 (42%) aged ≥60 years died without salvage therapy, and 19/60 (32%) adults aged <60 years and 37/151 (25%) aged ≥60 years were alive without receiving subsequent therapy by the end of the study period. The most common salvage therapy after CPX-351 was FLAG-based chemotherapy (aged <60 years: n=12/60; aged ≥60 years: n=17/151). Image:Summary/Conclusion: This study provides real-world survival outcomes in younger and older adults with AML who were treated with CPX-351 in England. These results suggest CPX-351 is an effective treatment for patients with AML aged <60 and ≥60 years in a real-world setting that bridged many patients to HCT, with promising post-HCT outcomes.